Objective: To report six cases of sterile inflammatory reactions to fine monofilament suture materials, which is exceedingly rare in ophthalmology.
Methods: We report six patients (four underwent penetrating keratoplasty and two underwent cataract surgery) with unusually severe local inflammatory reactions to suture material.
Results: Patients developed multiple focal inflammatory infiltrates and corneal oedema related to 10/0 monofilament nylon sutures. Four patients had evidence of either atopy or raised serum IgE and one had an autoimmune disorder (systemic lupus erythematosis). Onset was four to 11 days in five cases and six weeks in one. Allograft reaction occurred in two of the four corneal grafts, and three grafts failed. One of the cataract patients developed significant against-the-rule astigmatism. Microbial cultures of corneal scrapings, donor corneal rims, and suture material were generally negative. Polymorphonuclear leucocytes were noted on Gram stain in four cases, and cytology of corneal scrapings demonstrated eosinophils in one case.
Conclusions: Sterile inflammatory reactions to monofilament suture material are an uncommon complication of ocular surgery which may lead to corneal graft failure, and which is more common in atopic individuals. Systemic steroid therapy may be required.